The interaction between antenatal care and abnormal temperature during delivery and its relationship with postpartum care: a prospective study of 1,538 women in semi-rural Uganda

BMC Pregnancy and Childbirth

Research

Lisa M. Bebell¹  Mark J. Siedner²  Ingrid V. Bassett³  Godfrey R. Mugyenyi⁴  Joseph Ngonzi⁴  Adeline A. Boatin⁵  Nicholas E. Rahim⁶ 

[1] Department of Medicine, Division of Infectious Diseases, Medical Practice Evaluation Center, Center for Global Health, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, GRJ-504, 02114, Boston, MA, USA;Department of Medicine, Division of Infectious Diseases, Medical Practice Evaluation Center, Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, USA;Mbarara University of Science and Technology, Mbarara, Uganda;Department of Medicine, Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA;Department of Obstetrics and Gynaecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda;Department of Obstetrics and Gynecology and Center for Global Health, Massachusetts General Hospital, Boston, USA;Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, USA;

关键词: Antenatal care;    Postnatal care;    Pregnancy;    Delivery;    Postpartum;    Fever;    Hypothermia;   

DOI  :  10.1186/s12884-022-05207-8

 received in 2022-07-30, accepted in 2022-11-11,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundPostnatal care (PNC) is an important tool for reducing maternal and neonatal morbidity and mortality. However, what predicts receipt and maintenance in PNC, particularly events during pregnancy and the peripartum period, is not well understood. We hypothesized that fever or hypothermia during delivery would engender greater health consciousness among those attending antenatal care, leading to greater PNC engagement after hospital discharge and our objective was to evaluate this relationship.MethodsWomen were prospectively enrolledimmediately postpartum at Mbarara Regional Referral Hospital (MRRH). We collected postpartum vital signs and surveyed women by telephone about PNC receipt, fever, and infection at two and six weeks postpartum. Our outcome of interest was receipt of PNC post-discharge, defined as whether a participant visited a health facility and/or was hospitalized in the postpartum period. Our explanatory variables were whether a participant was ever febrile (> 38.0˚C) or hypothermic (< 36.0˚C) during delivery stay and whether a participant attended at least 4 antenatal care (ANC) visits. We used logistic regressions to estimate the association between ANC and fever/hypothermia with PNC, including an interaction term between ANC and fever/hypothermia to determine whether there was a modifying relationship between variables on PNC. Regression models were adjusted for age, marital status, parity, HIV serostatus, Mbarara residency, and whether the participant was referred to MRRH,ResultsOf the 1,541 women, 86 (5.6%) reported visiting a health facility and/or hospitalization and 186 (12.0%) had an abnormal temperature recorded during delivery stay. Of those who reported at least one visit, 59/86 (68.6%) delivered by cesarean, 37/86 (43.0%) reported post-discharge fever, and 44/86 (51.2%) reported post-discharge infection. Neither ANC attendance, abnormal temperature after delivery, nor their interaction term, were significantly associated with post-discharge PNC. The included covariates were not significantly associated with the outcome.ConclusionsWhile the overall proportion of women reporting post-discharge PNC was low, those who reported visiting a health facility and/or hospitalization had high proportions of post-discharge fever, post-discharge infection, and cesarean delivery, which suggests that these visits may have been related to problem-focused care. No significant associations between ANC and PNC were observed in this cohort. Further research assessing ANC quality and PNC visit focus is needed to ensure ANC and PNC are optimized to reduce morbidity and mortality.

【 授权许可】

CC BY   
© The Author(s) 2022. corrected publication 2022

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Fig. 1